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Historical perspective of low- vs. high-dose diuretics
1Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Journal of the American Society of Hypertension : JASH
|April 23, 2010
Summary
Thiazide diuretics, introduced 50 years ago, remain crucial for hypertension management. Lower doses are now preferred, reducing side effects while maintaining efficacy, especially in combination therapies.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Thiazide diuretics were introduced 50 years ago for hypertension treatment.
- Numerous thiazide and thiazide-like diuretics have since been developed.
- Early use involved high doses due to misconceptions about natriuresis.
Purpose of the Study:
- To review the evolution and current role of thiazide diuretics in hypertension management.
- To highlight the shift towards lower effective doses and their benefits.
- To emphasize the sustained importance of thiazides in antihypertensive therapy.
Main Methods:
- Review of historical data and clinical practice evolution.
- Analysis of dose-response relationships for antihypertensive and natriuretic effects.
- Assessment of adverse effect profiles at varying doses.
Main Results:
- Lower doses of thiazides are effective for hypertension and reduce side effects.
- The vasodilating effects of thiazides are key to their antihypertensive action.
- Thiazides enhance other antihypertensive drugs and allow for dose reduction.
Conclusions:
- Thiazide diuretics remain a cornerstone of hypertension treatment.
- Current practice favors lower doses, improving the benefit-risk ratio.
- Combination therapy with thiazides is highly effective for managing hypertension.
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